Showing papers by "Parikshit S. Sharma published in 2018"
TL;DR: Permanent cardiac pacing of the His-bundle restores and retains normal electrical activation of the ventricles and improves left ventricular ejection fractions during follow-up.
Abstract: Aims Permanent cardiac pacing of the His-bundle restores and retains normal electrical activation of the ventricles. Data on His-bundle pacing (HBP) are largely limited to small single-centre reports, and clinical benefits and risks have not been systematically examined. We sought to systematically examine published studies of patients undergoing permanent HBP and quantify the benefits and risks of the therapy. Methods and results PubMed, Embase, and Cochrane Library were searched for full-text articles on permanent HBP. Clinical outcomes of interest included implant success rate, procedural and lead complications, pacing thresholds, QRS duration, and ejection fraction at follow-up, and mortality. Data were extracted and summarized. Where possible, meta-analysis of aggregate data was performed. Out of 2876 articles, 26 met the inclusion criteria representing 1438 patients with an implant attempt. Average age of patients was 73 years and 62.1% were implanted due to atrioventricular block. Overall average implant success rate was 84.8% and was higher with use of catheter-delivered systems (92.1%; P 3 months follow-up; although, pulse widths varied at testing. Average left ventricular ejection fractions (LVEFs) were 42.8% at baseline and 49.5% at follow-up. There were 43 complications observed in 907 patients across the 17 studies that reported safety information. Conclusion Among 26 articles of permanent HBP, the implant success rate averaged 84.8% and LVEF improved by an average of 5.9% during follow-up. Specific reporting of our clinical outcomes of interest varied widely, highlighting the need for uniform reporting in future HBP trials.
173 citations
TL;DR: Permanent HBP was associated with significant narrowing of QRS duration and improvement in LV function in patients with RBBB and reduced LV ejection fraction and is a promising option for cardiac resynchronization therapy in patientsWith RBBBs and heart failure.
Abstract: Background Cardiac resynchronization therapy utilizing biventricular pacing is an effective therapy for patients with left ventricular (LV) systolic dysfunction, left bundle branch block, and heart...
115 citations
TL;DR: Inadvertent malpositioning of a cardiac implantable electronic device lead into the left ventricle is a rare complication of transvenous pacing and defibrillation and rapid identification of lead position is critical during implantation and just after the procedure, with immediate correction required if malpositioner is detected.
Abstract: Inadvertent malpositioning of a cardiac implantable electronic device lead into the left ventricle is a rare complication of transvenous pacing and defibrillation. Rapid identification of lead position is critical during implantation and just after the procedure, with immediate correction required if malpositioning is detected. If lead misplacement is discovered late after implantation, the lead should be surgically removed or chronic anticoagulation with warfarin should be instituted.
11 citations
23 Apr 2018
TL;DR: The right ventricular apex has been considered to be the primary site for ventricular lead implantation since the original descriptions of permanent pacing, but alternative sites of ventricular pacing, particularly the RV septum and His bundle, have been evaluated for patients with a need for long-term Ventricular pacing.
Abstract: The right ventricular (RV) apex has been considered to be the primary site for ventricular lead implantation since the original descriptions of permanent pacing. However, long-term RV apical pacing has been shown to have negative effects on ventricular function and hemodynamics as a result of ventricular dyssynchrony. Alternative sites of ventricular pacing, particularly the RV septum and His bundle, have been evaluated for patients with a need for long-term ventricular pacing. In this article, we review the available data on the use of these alternative sites for RV pacing.
6 citations
TL;DR: The authors hope to review the relevant anatomy of the bundle of His (HB) and help correlate PHBP implant characteristics with patient anatomy using fluoroscopic and electro-anatomic correlations.
2 citations
01 Nov 2018
TL;DR: Five patients who were CRT nonresponders are presented and the conventional and nonconventional approaches employed to achieve CRT benefit are discussed.
Abstract: Cardiac resynchronization therapy (CRT) is an established option for select patients with systolic heart failure. Nonresponse to CRT remains a significant problem. We present five patients who were CRT nonresponders and discuss the conventional and nonconventional approaches employed to achieve CRT benefit.
2 citations
1 citations
TL;DR: A 56-year-old female was hospitalized and her admission ECG differed from previous tracings, and knowledge of variant cardiac anatomy along with awareness of common pitfalls in ECG recording reveals the clinical diagnosis.
Abstract: A 56-year-old female was hospitalized and her admission ECG differed from previous tracings. Knowledge of variant cardiac anatomy along with awareness of common pitfalls in ECG recording reveals the clinical diagnosis and explains the difference.